Provider Demographics
NPI:1841370368
Name:CENTENNIAL MEDICAL GROUP INC.
Entity type:Organization
Organization Name:CENTENNIAL MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-326-8989
Mailing Address - Street 1:1801 16TH ST # A
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-5002
Mailing Address - Country:US
Mailing Address - Phone:660-326-8989
Mailing Address - Fax:661-326-8991
Practice Address - Street 1:1801 16TH ST # A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5002
Practice Address - Country:US
Practice Address - Phone:660-326-8989
Practice Address - Fax:661-326-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty